经后颅窝乙状窦后入路三叉神经微血管减压术的快速康复外科护理

目的 探讨快速康复外科 （FTS）理念在经后颅窝乙状窦后入路三叉神经微血管减压术围术期患者护理中的应用效果。方法 选择2018年1月~2019年1月我院收治并行经后颅窝乙状窦后入路三叉神经微血管减压患者100例，随机分成观察组和对照组，每组50例。对照组应用常规方法进行围术期护理，观察组应用FTS理念进行围术期护理。比较两组焦虑情况、术后并发症发生率、平均住院日及平均住院费用。结果 观察组轻度焦虑多于对照组，中、重度焦虑少于对照组（P＜0.05）；观察组术后并发症发生率低于对照组[恶心呕吐（4.00% vs 16.00%）、尿路感染（4.00% vs 18.00%）、颅内感染（0 vs 8.00%）、颅内血肿（2.00% vs 14.00%）和术后应激性疼痛（16.00% vs 34.00%）]，差异有统计学意义（P＜0.05）；观察组平均住院日和平均住院费用均低于对照组[（9.13±1.14）d vs（12.44±0.89）d]；[（2.15±0.66）万元 vs （3.05±0.61）万元]，差异有统计学意义（P＜0.05）。结论 应用FTS理念能缓解经后颅窝乙状窦后入路三叉神经微血管减压术患者术前紧张恐惧的心理，减少术后并发症，缩短患者住院日，降低住院费用，护理效果较好。     

ADAM33 polymorphisms and susceptibility to allergic rhinitis: a meta-analysis

European Archives of Oto-Rhino-Laryngology - Several polymorphisms in a disintegrin and metalloproteinase 33 (ADAM33) have been implicated in susceptibility to allergic rhinitis (AR), but the...     

Severe lumbar spinal stenosis combined with Guillain-Barré syndrome: A case report

BACKGROUNDGuillain-Barré syndrome (GBS) is a rare disorder that typically presents with ascending weakness, pain, paraesthesias, and numbness, which mimic the findings in lumbar spinal stenosis. Here, we report a case of severe lumbar spinal stenosis combined with GBS.CASE SUMMARYA 70-year-old man with a history of lumbar spinal stenosis presented to our emergency department with severe lower back pain and lower extremity numbness. Magnetic resonance imaging confirmed the diagnosis of severe lumbar spinal stenosis. However, his symptoms did not improve postoperatively and he developed dysphagia and upper extremity numbness. An electromyogram was performed. Based on his symptoms, physical examination, and electromyogram, he was diagnosed with GBS. After 5 d of intravenous immunoglobulin (0.4 g/kg/d for 5 d) therapy, he gained 4/5 of strength in his upper and lower extremities and denied paraesthesias. He had regained 5/5 of strength in his extremities when he was discharged and had no symptoms during follow-up.CONCLUSIONGBS should be considered in the differential diagnosis of spinal disorder, even though magnetic resonance imaging shows severe lumbar spinal stenosis. This case highlights the importance of a careful diagnosis when a patient has a history of a disease and comes to the hospital with the same or similar symptoms.     

免疫检查点抑制剂应用于晚期胃癌治疗的研究进展

我国属胃癌高发国家,且以进展期胃癌为主。以手术和化疗为主的多学科治疗无法有效改善晚期胃癌患者的预后。近年来,免疫检查点抑制剂类药物的疗效在诸多癌症中得到了证实,因此,该类药物在胃癌中的治疗效果也受到了广泛的关注。本文对近年来的相关研究成果进行综述,全面介绍了免疫检查点抑制剂类药物在胃癌治疗中的临床应用情况、联合用药情况以及不良反应。对于其他治疗均失败的晚期胃癌患者,PD-1抑制剂是一个可行的治疗选项,其代表药物派姆单抗是目前唯一被美国食品药品监督管理局批准应用于胃癌治疗的免疫抑制剂类药物,而我国国家食品药品监督管理总局尚未批准任何此类药物应用于胃癌的临床治疗。如何进一步提高治疗的客观缓解率,将会是后续临床和基础研究的一大焦点。     

应用国产封堵器在治疗先天性心脏病的临床疗效分析

目的 总结国产封堵器经皮和经胸途径治疗先天性心脏病的临床疗效。方法 回顾性分析我院2013年1月至2017年12月在X线透视下或单纯超声心动图引导下采用经皮穿刺股静脉或股动静脉法，或者食管超声心动图监测下经胸小切口行先天性心脏病封堵1186例，其中经皮X线下封堵1081例、经皮单纯超声引导下封堵42例、经胸封堵63例；其中动脉导管未闭（ patent ductus arteriole，PDA）426例、房间隔缺损（atrial septal defect，ASD）363例、室间隔缺损（ventricular septal defect，VSD）348例、卵圆孔未闭11例、房间隔缺损合并室间隔缺损9例、房间隔缺损合并动脉导管未闭6例、房间隔缺损合并肺动脉瓣狭窄（pulmonary stenosis，PS）12例、动脉导管未闭合并肺动脉瓣狭窄8例、主肺动脉侧支封堵3例[经胸封堵66例改为63例，PDA443例改为426例]。结果 全组病例成功率98.2％（1165/1186），无死亡病例。随访1~36个月，术后第1、3、6、12个月及术后每年常规行超声心动图及心电图检查。术后第1、6、12个月的随访率分别为 92.9%（1102/1186）、84.1%（998/1186）、70.5%（836/1186）。超声心动图提示少量残余分流（<3 mm）18例；三尖瓣少量反流33例，中量反流5例；主动脉瓣轻度反流5例，中度反流1例；心律失常Ⅲ°房室传导阻滞（Avionics Bulletin，AVB[房室传导阻滞（Avionics Bulletin，AVB）]）1 例，Ⅱ°AVB 3例，完全性左束支3例，交界性心动过速3例，交界性逸搏2例。结论 国产封堵器在先天性心脏病封堵治疗中具有成功率高、创伤小、并发症低、操作容易、疗效确切、恢复快等特点，是治疗先天性心脏病的理想方法。